Cerebral Hemodynamics and Autoregulation in Reversible Posterior Leukoencephalopathy Syndrome Caused by Pre-/Eclampsia

204 ies and 50% basilar artery stenosis confi rming the thrombotic nature of the stroke. No cardiac source of embolism was found. Therefore, given the initial evidence of right vertebral artery occlusion by magnetic resonance angiography, we suspect that the progression to bilateral involvement was due to occlusion of a penetrating branch, although unfortunately the autopsy report did not focus on the origins of the anterior spinal arteries and no cerebral angiogram was performed. MMS accounted for less than 0.5% of all cerebral infarcts in one series [1] and a similar number was reported in a 700-autopsy report [7] . Up to 1996, only 40 well-documented cases were reported [6] , and this condition still remains a diagnostic challenge because of the heterogeneous clinical presentations [6] . In our patient the presence of upbeat nystagmus was an important diagnostic clue. It is thought to be secondary to medial longitudinal fasciculus involvement, although others proposed the involvement of the nucleus intercalatus of Starderini [8] . However, previous reports underemphasized the diagnostic importance of the upbeat nystagmus [1] , including the largest case series of MMS published in 1995 and 2004 [9, 10] because of the heterogeneous clinical presentation of the MMS. In summary, we present the fi rst concomitant DWI and autopsydocumented case of progression of right to bilateral anteromedial medullary ischemia. It also points to the need of early suspicion of peritonitis or other abdominal infection in patients with bilateral brainstem ischemia and unexplained fever. Similar to patients with spinal cord injury, they may develop threatening abdominal infections without the classical signs of peritoneal irritation [11] .